Under-Eye Fat Repositioning - SM Plastic Surgery

Fat repositioning does not remove the protruding orbital fat entirely; it moves the fat down into the hollow of the tear trough and fixes it. Simply removing fat can leave the under-eye looking hollow over time, so the aim is to smooth the step between the bulging and hollow areas together. The extent of repositioning varies with the under-eye, so the decision follows a detailed assessment.

Dark circles have many causes: vessels showing through, pigmentation, or a structural type where protruding fat and a hollow tear trough cast a shadow. Under-eye fat repositioning can help ease the structural shadow, but pigmented and vascular dark circles call for a different approach, and the degree of improvement differs with the type. Distinguishing the cause first matters most.

Approaching the fat through the conjunctiva on the inner side of the lower lid does not cut the skin, so a visible scar is unlikely. Where under-eye skin laxity is clear, however, another method such as lower blepharoplasty may be needed, and the approach then changes. The method that suits is decided after assessing the under-eye.

Fat repositioning moves the protruding fat mainly through the conjunctiva, settling the bulge and hollow, and suits those with little skin laxity. Lower blepharoplasty opens the under-eye skin and refines stretched skin and muscle as well, considered where laxity is clear. Depending on the state of fat, skin and wrinkles, the method that suits is chosen — or the two are combined.

The repositioned fat is your own tissue, moved and fixed in place; but as time passes and the area ages, the contour beneath the eye can change. Refining the septum and fixing the fat aims to reduce the chance of recurrence, though how well it holds differs with each person's tissue and how ageing progresses. The course is followed, and supplementary options can be discussed where needed.

The approach through the conjunctiva inside the lower eyelid is mainly considered for patients in their 20s and 30s whose under-eye skin still has relatively good elasticity. Because the skin is not incised, there is less burden of a visible scar, but sagging skin itself cannot be trimmed away. When elasticity has declined from the 40s onward, lower blepharoplasty with an incision is reviewed together. Director Lee Muyoung examines the under-eye area directly to decide which approach fits.

For under-eye fat repositioning through the conjunctiva, we generally guide about three days to return to daily life and about three days for the swelling to settle. The pace at which swelling and bruising fade varies from person to person, so please mention any fixed schedule during your consultation. Recovery is monitored at follow-up visits.

A dark-looking under-eye area may come from the shadow cast by bulging fat, the shade created by sagging skin, or pigmentation, and the approach differs by cause. When bulging is the main cause we consider fat repositioning, and when skin laxity is the main cause we review lower blepharoplasty as well. When pigmentation is the cause, surgery alone has its limits, so other methods are reviewed together. Which cause is dominant is determined after a detailed examination.

Hyaluronic acid filler softens the contour by filling a hollow, so it is absorbed over time and cannot move the bulging fat itself. When the cause is the step between under-eye bulging and the tear-trough hollow, repositioning that moves and fixes the fat is considered. Since the suitable method differs with the condition of the under-eye area, we examine it directly during the consultation and advise accordingly.

Regardless of age, when the septum supporting the orbital fat weakens, the fat pushes forward and the under-eye area can look bulged. If skin laxity is not pronounced, repositioning through the conjunctiva is often considered first. The plan still changes with the amount of fat and the depth of the tear-trough hollow, so it is decided after a detailed examination.

When there is not enough fat to move, repositioning alone may not fill the hollow, and fat grafting may need to be considered together. Transconjunctival repositioning has limits when there is skin laxity, weakened under-eye muscle, insufficient fat volume, midface hollowing, or pigmentation, so combining other methods is reviewed. The amount of fat is checked directly during the consultation.

The Hamra technique, published by Dr. Sam T. Hamra in 1995, works on the concept of moving under-eye fat into the hollow and fixing it there instead of removing it. SM Plastic Surgery performs the Hamra technique, the transconjunctival Hamra technique, lower blepharoplasty and under-eye fat repositioning. Which approach is used is decided after assessing under-eye skin elasticity and the state of the fat.

When the approach is made through the conjunctiva inside the lower eyelid, the skin is not incised, so removing stitches from the outside is usually not required. If a skin incision is combined depending on the under-eye condition, stitch removal may be needed; in that case about a week is the standard, sometimes as early as day five and as late as two weeks. Which approach will be used is explained when the surgical plan is set.

After under-eye fat repositioning, swelling, bruising, conjunctival edema, asymmetry and a sense of unevenness may appear, and rarely the repositioned area may feel firm. Some of this can be temporary during recovery, so rather than judging on your own it is better to visit the clinic and have the area checked. Director Lee Muyoung reviews the course directly and advises on what is needed.

The procedure takes about 30 minutes to an hour and is performed under local or sedation anesthesia. We generally guide one to two follow-up visits, which may vary with the under-eye condition and the extent of repositioning. The anesthesia method is decided at the consultation after your general health is reviewed.